Playing to Our Vanity

The perfect body may not come in a bottle, but that doesn’t stop many people from wondering: Could it come in a capsule? From a full body wrap? Perhaps one of those new abdominal stimulators would make a difference.

To wonder is not to be entirely naive. The alternative, after all, is to accept a future in which the only answer for an out-of-shape body is a long, grim dose of leafy greens--and exercise. Or worse. “I sure don’t know of any way to lose 100 pounds in five weeks, and keep it off,” said Judith Stern, a professor of nutrition and internal medicine at UC Davis. “Except maybe amputation.”

And so despite strong native skepticism, many consumers reserve a wisp of hope, and thereon hangs a $5-billion to $10-billion industry of body-shaping products, from supplements to new spa treatments. In recent years these products’ claims--melt away pounds as you sleep; increase breast size; lose weight without changing your diet--have become bolder, and more frequent, say those who watch the industry. “There’s been a dramatic increase in the amount of advertising and the number of products out there” in the last 10 years, said Rich Cleland, a senior attorney in the advertising division of the Federal Trade Commission, which enforces consumer protection laws prohibiting deceptive practices. Cleland attributes much of this increase to the explosive growth through the 1990s of the dietary supplement industry, which includes such things as herbs, vitamins and diet and nutrition products. Especially on the Internet, pitches for weight loss and body shaping products have adopted a scientific tone. In addition to the standard before-and-after pictures, testimonials and endorsements from unfamiliar doctors, many ads now include references to clinical studies, body mass indexes, bio-availability of nutrients and so on. “They have picked up all the same medical jargon you would get from a reputable medical source” such as the Mayo Clinic or the National Institutes of Health, said Stern.

Federal law prohibits companies from making false marketing claims about the health benefits of products. Companies can say a product “promotes” weight loss, for instance, but cannot claim that it prevents or cures a specific health condition. Companies are also not supposed to make health claims that are not substantiated by research, under penalty of settlements that can run into the millions of dollars.

Such products proliferate nonetheless, because regulators concede that they lack the staffing or resources to police all of them. Carefully worded ads--making generous use of words such as “suggest,” “may” and “could”--can sometimes mislead without actually violating the law, some industry critics contend.

Several popular products illustrate the appeal of products that promise a easier way to make our bodies beautiful.

Breast Enhancement

Can pills containing a special blend of natural herbs enhance a woman’s cleavage, making breasts firmer and more attractive, without the need for surgical implants or a breast lift? A host of ads and infomercials beckon with claims that such products can transform a woman’s breasts, enabling the user to “gain back the firmness you had as a teenager.”

Doctors and herbal medicine experts say that a few of the ingredients could have some visible effect on the breast, although they don’t know if that’s a result of swelling or new cell growth. Unlike prescription drugs, which must undergo a lengthy approval process before being allowed on the market, the FDA does not require makers of dietary supplements to demonstrate that their products are safe or effective. Doctors also express concern that the herbal ingredients contained in some products have not been studied to determine if any adverse health effects might result.

Two of the products being promoted for “natural” breast enhancement are sold under the names Breast Assure and Bloussant. The products have several herbs in common, including saw palmetto (a traditional folk treatment said to make breasts larger), dong quai (an herb long used in China for gynecological ailments), damiana leaves (used as an aphrodisiac), dandelion, blessed thistle and wild yam.

Bloussant also contains fennel seed, used as a folk remedy to increase breast milk in nursing women and to increase libido; watercress, a leaf with antibiotic and diuretic actions; and black cohosh, often taken to relieve the hot flashes of menopause.

Breast Assure also has fenugreek, an herb used in folk medicine to encourage breast milk production.

According to Home Health, the Bohemia, N.Y.-based maker of Breast Assure, the product contains vitamin C and collagen “to support the underlying structure of the breast,” and chaste tree fruit, which “has been shown to help with breast tenderness,” said Ona Scandurra, director of nutrition communications for Home Health. Asked for specific effects on the breast, she said: “It helps nourish them. It provides ingredients for the cells and tissues.”

The company does not claim that Breast Assure increases breast size, Scandurra noted. Rather, Breast Assure’s ads say the product promotes “firm-looking breasts” and “bust enhancement.”

Dr. Mary Hardy, chief of integrative medicine at Cedars-Sinai Medical Center in Los Angeles, said she doesn’t see much downside to the herbal ingredients in the breast-enhancement potions, with one exception. She noted that Breast Assure contains kava kava, an herbal relaxant and sleep aid that has been linked to liver failure in half a dozen reports from Germany and Switzerland. Britain’s Medical Control Council has negotiated the removal of the herb from stores. The FDA is investigating the herbal supplement.

“There’s some reason to be cautious about taking kava kava on a regular basis until we straighten it out,” Hardy said.

Wellquest International, the New York-based maker of Bloussant, says in print advertisements and television infomercials that its herbal product can “actually stimulate the inner-cellular substance in the breast that becomes dormant during the teenage years.” Attempts to reach a company spokesman to clarify that statement were unsuccessful.

Because excessive exposure to estrogen promotes cancer, Dr. Maida Taylor, a UC San Francisco gynecologist who has studied the effects of herbs on women’s hormones, worries that “anything that stimulates the breasts like estrogen” might carry similar risks.

Although these supplements are relatively inexpensive compared with the thousands of dollars a woman might spend on plastic surgery, they are more than an incidental expense. A 30-day supply (about 180 capsules at the recommended dose) of Breast Assure costs $49.95, plus another $49.95 if you buy the four-ounce bottle of herbal firming lotion. A two-month supply of Bloussant costs $229.95, according to the company.

Wellquest’s Web site says some women may be able to stop using Bloussant once they’ve achieved “optimum size and firmness,” but others “have to take Bloussant two or three times a week to keep the firmness and the size.”

Breast Assure is recommended for use every day.

Body Wraps

The idea is seductive: Wrap yourself up like a mummy in bandages drenched in herbal potions, and emerge an hour later inches slimmer. Suddenly, your favorite jeans or skintight party dress slips on effortlessly. Indeed, some women who regularly use body wraps swear by them. And it’s certainly become a thriving business.

Day spas and other health and beauty salons throughout Southern California charge $80 and more for wraps that are said to slice inches from the waist, thighs, buttocks, calves, arms or tummy.

One of the biggest companies in the field, Suddenly Slender, headquartered in Clearwater, Fla., said it has licensed its proprietary body wrap to more than 1,100 salons in the U.S. and abroad. Patrons are wrapped from head to toe in cloth bandages that are soaked in the company’s SlenderTone solution, which is said to contain minerals to help the body purge waste products, tighten skin, compact tissue, and firm up the body.

Some doctors are skeptical that body wrap procedures can permanently melt away fat or dissolve cellulite, those deposits of ordinary fatty tissue that women tend to get on their thighs and buttocks. Any loss of inches or weight is probably temporary, the result of sweating and water loss in the tissues, these doctors said.

“The change might last for an evening but it wouldn’t be permanent,” said Dr. Brian M. Kinney, a Century City plastic surgeon and spokesman for the American Society of Plastic Surgeons. “The wraps definitely sweat off pounds but when the body reestablishes its water balance, you gain the weight back.”

For some people, looking better for the office party or high school reunion may be benefit enough to justify the cost.

But doctors warn that, in rare instances, a body wrap may present a health risk if it causes severe dehydration or circulatory problems. “Binding yourself up like a mummy can throw you into hypovolemic shock because not enough blood gets to your brain,” said Dr. Victor D. Herbert, a hematologist at Mt. Sinai Veterans Research Center in New York, a frequent critic of alternative health therapies.

Still, even these remote risks don’t deter people such as Crystal Barron, a 32-year-old singer from Los Alamitos who used body wraps to firm up after shedding 30 pounds. Although she didn’t notice a loss of inches, Barron said the wraps “dramatically improved my skin tone, and smoothed out the cellulite on my legs.”

“This is truly a cosmetic wonder,” said Lorraine Urbina, a chiropractor who offers the Suddenly Slender body wrap formula at her Los Alamitos office. Her customers spend an hour swaddled in cloth bandages that are dipped in minerals which, she said, draw out the toxins in the body. The wraps, she said, “compress the fat cells, making skin look smoother.”

The wraps won’t, however, “increase muscle mass or get rid of fat,” she added. “Only dieting and exercise will do that.”

“There’s no medical proof this eliminates fat cells,” said Kinney, the plastic surgeon. “If you wrap part of your body very tightly, it moves a little bit of fluid around. But that’s about it, and it comes right back.”

Chitosan as Diet Aid

The appeal is hard to resist: a capsule that flushes fat out of the body after it has passed your lips--and before it lands on your hips.

That’s the promise of products containing chitosan, a substance derived from shellfish that has quickly become one of the most popular and controversial diet aids on the market.

The Federal Trade Commission has taken action against several companies for making deceptive claims about chitosan. In 1999, the agency won a federal district court case against SlimAmerica Inc.; the company was ordered to pay $8.3 million for violating consumer protection laws prohibiting false advertising. In 2000, Enforma Natural Products Inc., makers of Fat Trapper Plus products, agreed to pay $10 million to settle an FTC complaint that it made deceptive weight-loss claims on infomercials, such as “With Enforma, you can eat what you want and never, ever, ever have to diet again.”

Enforma pulled the infomercials off the air but is still locked in a dispute with the FTC over its marketing practices. The company continues selling chitosan products and insists they are safe and effective. “We have a thousand testimonials showing that the Fat Trapper products work,” said Drew Grey, chief executive of Enforma, which is based in Woodland Hills. He said Enforma used to make some “heavy claims” about several different products, but that the weight-loss benefits of chitosan are nonetheless real. “We have a long list of experts and reliable information to back up our claims,” he said.

Certainly the products remain popular. Consumers spent nearly $300 million on chitosan products such as Fat Magnets, Fat Trapper Plus and Chitosol last year, according to Nutrition Business Journal, which tracks marketing data. “The products are still popular, and the main reason is that people have heard that you can eat all the fat you want and still lose weight while using it,” said Susan Bowerman, assistant director of UCLA’s Center for Human Nutrition.

In test tube studies, the chitosan molecule quickly binds to fat molecules, scientists say. When stirred into a container of bacon grease and water, for example, chitosan preparations can turn the fat into a big, gelatinous glob that sinks to the bottom--an effect that was demonstrated on infomercials. “People saw that on the infomercials and said, ‘Wow.’ It’s very persuasive,” said Bowerman. “But the intestines are full of bicarbonates and acids and all sorts of things” and it’s not yet clear how these interact with the chitosan.

Enforma officials say numerous research studies support chitosan’s effectiveness as a weight-loss supplement.

But nutrition researchers say the two most scientifically rigorous trials of chitosan have shown little effect. In one, English researchers separated 34 overweight volunteers into two groups--one that received chitosan capsules twice daily and another that got capsules containing no chitosan. Participants were instructed to maintain their usual diets. After four weeks, there was no significant weight reduction in either group, the doctors reported. In the other experiment, involving 51 obese women, researchers in Finland reported similar results.

The amount of fat that a few chitosan capsules ferry out of the body is probably negligible, some nutritionists say. In 2001, UC Davis researchers studied seven healthy men who were all put on the same, high-fat diet. The men excreted the same amount of fat in their feces, whether taking chitosan supplements or not. “I expected to find some difference, something,” said Judith Stern, the lead author. “But I got nothing, no difference--zero, zip, zilch.”

If people who use the products do lose weight, Bowerman said, it is more likely because of other lifestyle changes, such as exercising more or consuming fewer calories. “People want to believe it’s the chitosan, but in reality they’re following a different regimen.”

When it comes to any weight-loss product, experts have two words: caveat emptor. “I don’t know what more to say except: Be extremely skeptical,” said Stern. “Weight loss is a daily constant battle and I know personally of what I speak. It’s not because you’re bad person or weak-willed; it’s that maybe genes are not so great, and it’s just a fight. It always will be.”

Toning the Abs

If you haven’t ordered one of those gizmos that apply electric stimulation to the abs--thus toning and firming the flab-prone tissue--surely, you’ve heard about them.

The products, based on technology long used in physical therapy, are suddenly being touted for use by people who want to get in shape. One such device has actually received approval from U.S. regulators--setting it apart from similar ab stimulators. In September, the Food and Drug Administration for the first time approved an ab stimulator for toning uninjured muscles. That product, called Slendertone Flex, is expected to be sold in the United States later this month, according to the company.

The approval appears to have sparked a race among the manufacturers of similar products to rev up advertising on their Ab Energizers, ToneATronics and FastAbs.

But some exercise physiologists remain skeptical that such products will give the average consumer noticeably tighter, flatter abs.

“At present there is not a lot of peer-reviewed credible scientific evidence on how they really work, or if they really work, in a normal, healthy population,” said William J. Kraemer, an exercise physiologist at the University of Connecticut.

A study on ab stimulators, scheduled to be published in the Journal of Strength and Conditioning Research later this year, shows that they had no effect on firming abdominal muscles of healthy people, added Kraemer, who edits the journal.

Electrical stimulation has long been used to help muscles weakened by illness or injury. By delivering small jolts of electricity, the stimulators cause the muscle to contract, thereby exercising it. (The electrical current has to be large enough to cause a contraction, but weak enough to avoid pain or burns.) Because of their use in rehabilitative medicine, the products are regulated as medical devices that require FDA approval prior to marketing.

The agency had long warned consumers against nonmedical uses of the stimulators. The devices can cause burns and skin irritation or, placed improperly, could even cause breathing problems or heart arrhythmia, FDA officials said.

But, they add, the FDA wanted to consider electrical muscle stimulators for consumer use in order to set some safety standards and because it appears consumers are going to use them anyway.

“Clearly what we were seeing was that these devices are out there and are being promoted,” said Dan Schultz, deputy director for the FDA’s Office for Device Evaluation. “The question at that point became, what is the best thing for us to do to make sure consumers were protected and that the information being disseminated was supported by some scientific data?”

The FDA approved Slendertone Flex because the manufacturer provided data showing that the device was useful in “firming, toning and strengthening the abdomen” in people of normal weight who use the device on a regular basis.

In Slendertone’s study, 72 women were assigned to use the Slendertone--or nothing--for eight weeks. The women who used the product showed an average increase in muscle strength of 12% while the control group showed no such improvement. The women who used Slendertone also reported improvements in muscle firmness and in their self-image.

“It typically takes eight weeks to see substantial benefits,” said Colin Lawlor of Bio-Medical Research Ltd., the Irish company that makes Slendertone Flex. “Like any other exercise, you need to continue its use two to three times a week to keep the results.”

Unlike some similar products, which typically sell for $40 to $80, the $200 Slendertone Flex does not require the use of a gel to affix the electrodes.

The FDA’s Schultz cautioned that not everyone who uses the approved Slendertone Flex device should expect “to look like Arnold Schwarzenegger.” The data, he noted, show that the product “is reasonably safe, and ... indicates that at least some patients will have some benefits as far as toning and firming their muscles.”

Ab stimulators that lack FDA approval won’t necessarily be pulled from the market, officials said, because the agency is giving manufacturers an unspecified amount of time to comply with the approval requirements.

But, they added, consumers who use a product without FDA approval cannot be assured of the device’s safety or effectiveness.